2018 MIDTERM ELECTION

OK, I admit this caught me by surprise; last year the first following-year rate increase requests didn't start popping up in the major media until late May (or perhaps they did but I didn't happen to notice until then). My first entry on the subject wasn't until May 17, 2014.

This year, the first state out of the gate with the proposed rate changes is Oregon. There's a reason why I'm emphasizing "requested" and "proposed" here...because it's very important for people to understand that in most states, anyway, the state insurance commissioner can veto rate increases which are out of line. An insurance company can ask for a 10,000% increase...that doesn't mean they're gonna get it.

I've written a lot about the impending King v. Burwell Supreme Court decision, and some of my ideas have been batted around by Very Serious People® here and there. However, I'm not a lawyer, nor am I a Constitutional scholar or a Supreme Court scholar, so I'm not the right person to talk to about the actual legal/procedural side of things.

Fortunately, Nicholas Bagley (an assistant law professor at U of M) and David K. Jones (an assistant public health professor at Boston University) have written a lengthy, comprehensive legal analysis of just what the options would be for the federal government and/or the states in the event that the King v. Burwell plaintiffs win their case.

Be warned: It's a long read that gets deep into the weeds, but is well worth it to understand the seriousness of a potential plaintiff win.

Gov. Scott: We Will Begin Working Immediately on a Budget to Continue Critical Programs & Start Conversation on Healthcare Access and Cost

On April 30, 2015, in News Releases, by Currie Dickerson

TALLAHASSEE, Fla. – Governor Rick Scott released the following statement today upon the adjournment of the Florida Senate upon the call of the President, and after the Tuesday adjournment of the Florida House:

“Now that the Florida Senate and House have adjourned, we must immediately turn our focus to how we can work together to craft a state budget before July 1st that continues funding for critical state services. There were no discussions about Medicaid expansion under Obamacare before the legislative session began. Today, it is clear that a thorough analysis of how healthcare can be reformed to improve cost, quality and access is needed, apart from the budget process.

There's not one, not two, not three but four articles I'm reading this morning centering around the same theme: GOP governors who are finally starting to at least consider expanding Medicaid under the Affordable Care Act, but only if the enrollees jump through various hoops in order to qualify:

In nearly a dozen Republican-dominated states, either the governor or conservative legislators are seeking to add work requirements to Obamacare Medicaid expansion, much like an earlier generation pushed for welfare to work.

The move presents a politically acceptable way for conservative states to accept the billions of federal dollars available under Obamacare, bringing health care coverage to millions of low-income people. But to the Obama administration, a work requirement is a non-starter, an unacceptable ideological shift in the 50-year-old Medicaid program and a break with the Affordable Care Act’s mission of expanding health care coverage to all Americans. The Health and Human Services Department has rejected all requests by states to tie Medicaid to work.

Democratic Gov. Steve Bullock signed the Montana Health and Economic Livelihood Partnership (HELP) Act into law Wednesday in the Capitol rotunda as hundreds of people cheered.

The bill was introduced by Republican Sen. Ed Buttrey of Great Falls after lawmakers defeated the governor's expansion proposal.

Buttrey calls the plan the most conservative in the nation due to copays, premiums and other provisions. Because of those items, the state must seek a waiver from the federal government to put the program in place.

Assuming the vast majority of those eligible enroll (which seems to be the case in most states which have gone through with expansion to date), we should be able to chalk up another 35,000 - 70,000 Medicaid expansion enrollees over the rest of the year.

First, I have to clarify that while the data from the first and second (numeric) columns (and therefore, the third as well) are pretty solid, I'm still making a lot of assumptions for the 4th, 5th and 6th columns below.

The numbers in the first column (2014 EOY Total) come from the just-released Kaiser Family Foundation Data Note, which in turn is based on the Health Coverage Portal by Mark Farrah Associates. That's the total number of people enrolled in private, individual healthcare policies, regardless of whether they were purchased via the ACA exchanges or not.

The second column (2014 EOY Exchange (Estimate)) is my best estimate of how many people had effectuated enrollmentsthrough the ACA exchangesas of 12/31/14. Those are all important caveats. These numbers are based on the following:

A week or so ago I noted that the new Kaiser Family Foundation monthly tracking poll strongly (if indirectly) supports my estimate of roughly 8.5 million OFF-exchange QHP policy enrollees for 2015 (actually likely closer to 8.6 - 8.7 million by now).

As of the end of open enrollment in 2014, 8 million people had signed up for coverage through the Marketplaces. Accounting for the fact that some of those people did not pay their premiums or subsequently dropped coverage – and for signups through special enrollment periods throughout the year – 6.7 million people were insured through marketplace plans as of October 15, 2014. However, it has been unclear precisely how many of these Marketplace enrollees were previously uninsured or how many would have purchased individual coverage directly from an insurer in the absence of the ACA.

Kaiser Family Foundation analysis of recently-submitted 2014 filings by insurers to state insurance departments (using data compiled by Mark Farrah Associates) shows that 15.5 million people had major medical coverage in the individual insurance market – both inside and outside of the Marketplaces – as of December 31, 2014. Enrollment was up 4.8 million over the end of 2013, a 46% increase.

Testimony before the Senate Committee on Small Business and Entrepreneurship
by MICHAEL F. CANNON April 29, 2015

...If the Court sides with the challengers, its ruling will free more than 57 million employers and individuals in those federal-Exchange states from the ACA’s employer and individual mandates. Those 57 million Americans include Kevin Pace, a jazz musician and Virginia resident whose income fell by $8,000 when his employer cut his hours to avoid the IRS’s illegal taxes. They include small-business owners who would expand and hire more workers, but are prohibited from doing so by threat of illegal taxes. A ruling for the challengers would protect small businesses and their employees from an out-of-control IRS. Such a ruling would cause a smaller number of Americans —an estimated 6.7 million — to lose access to subsidies that no Congress ever authorized.

Maryland had 120,145 QHP selections during open enrollment. Assuming my combined #ACATaxTime + "normal" Off-Season enrollment rate estimate of roughly 10,500 people per day nationally (through Thursday the 30th, anyway) is accurate, MD's share of this should be roughly 1% of this, or around 108 people per day at the moment. Even then, only around 1/3 of the total would be specifically for the tax season special enrollment period (the others would presumably just be delayed by a few days).

MORE THAN 33,000 CONSUMERS UNAWARE OF TAX PENALTY FOR BEING UNINSURED HAVE ENROLLED IN HEALTH INSURANCE THROUGH COVERED CALIFORNIA SINCE FEBRUARY
Those Without Health Insurance Have Three Days to Enroll in Covered California to Minimize Penalty for Being Uninsured in 2015

SACRAMENTO, Calif. — With just two days until the April 30 deadline, Covered California urged consumers on Tuesday to enroll in health coverage and announced that more than 33,000 people who signed up since February indicated they were unaware of the tax penalty for being uninsured. The 33,000 enrollees were among more than 91,000 consumers who enrolled in coverage through special enrollment since open enrollment ended in February.

Not that anyone's reading today (all eyes are on either Baltimore or the Supreme Court, with good reason), but this is a nice little ancillary benefit of the Affordable Care Act:

Dear Charles,

Thought you'd appreciate this.

Some imposter used my SSN to file a tax return this year, which I found out when I tried to e-file. I've done all the identity theft things, filed my return on paper with the identity theft affidavit from the IRS website, etc. etc. But I wondered whether the fraudster had gotten several thousand dollars out of the Treasury.

Today I got a letter from the IRS, saying they couldn't process my 1040EZ return because it didn't include the Health Insurance tax form, reconciling the subsidy I got (which their computer had matched up with my return) with the credit I was actually entitled to.

I haven't filed a 1040EZ since maybe 1975, so this was obviously the fraudulent return, not my real one. (My real one has the health insurance form on it, of course.) I was delighted that their filter matched ACA information against the return before sending out the refund. I called the IRS to let them know, and will follow up with the IRS in writing to make sure they don't send any refund.

The reason it's bobbling around the 600K mark, of course, is because of normal "churn" as people move onto/off of the program as they gain/lose jobs, move into/out of the state, give birth/lose family members and so forth.

A few days ago, YouGov.com posted the results of their own survey about the ACA, which showed pretty much exactly the same results as both the Bloomberg News and Kaiser Family Foundation polls released last week: Obamacare still isn't exactly beloved, but acceptance/approval of the law has been gradually (if grudgingly) increasing ever since the ugly rollout of the ACA exchanges a year and a half ago:

I didn't bother posting about this poll because it seemed a bit redundant; all 3 surveys asked questions in different ways, but the results are pretty consistent across the board.

Here's a conundrum for today's Florida Republicans: You love tax cuts and hospital corporations while hating education and poor people.

You're all set to slash taxes (again) while also giving hospitals $1.3 billion from the federal government to reimburse them for losses they incur from treating poor people who can't afford to pay their bills.

At the same time, you're kind of a huge jerk, so you refused to expand Medicaid to over 800,000 of your residents, even though you won't have to pay a dime for the first 3 years, a few percent for the next few years and no more than 10% of the cost after that.

The Supreme Court rules that you don't have to do so, so you get to spend a couple of years laughing in the face of 800K low-income people while simultaneously rubbing the Obama Administration's nose in your ass-jackery.

Finally, the HHS Dept. decides to fight back by threatening to pull that $1.3B away from your hospitals unless you play ball.

Suddenly, you're in a bind. If you cave, then terrible things will happen: 800,000 people will receive decent healthcare coverage and you'll be found guilty by your fellow Republicans of having a soul. The Horror! Can't have THAT happen!!

I live in Michigan, but I've never heard of Patrick Colbeck. All I know about him is that he wrote an Op-Ed piece for the Detroit News on Friday which has more factual holes than the swiss cheese I put on my turkey sandwich last week:

Obamacare’s days are numbered. Either the Supreme Court will strike it down via rulings on cases like King v. Burwell, it will be repealed in 2017, or it will implode on itself taking the health of many of our citizens with it.

A couple of days ago, the editiorial board of the News posted an editorial which correctly calls for the renewal of Healthy Michigan, which requires a federal waiver once a year (I think) in order to continue because it includes modifications from simply increasing the eligibility threshold to 138% of the Federal Poverty Level.

Satisfaction with the Health Insurance Marketplace exchange enrollment process among new enrollees has significantly increased from 2014, and health plans obtained through the Marketplace exchange generate levels of member satisfaction equal to or higher than plans not obtained through the Marketplace exchange, according to the J.D. Power 2015 Health Insurance Marketplace Exchange Shopper and Re-Enrollment (HIX) StudySM released today.

For months now, whenever I've crunched the numbers to figure out how many people would be screwed by an adverse King v. Burwell ruling by the Supreme Court (answer: around 6-7 million directly, plus another 6-7 million indirectly), I've always made sure to include one caveat: A small percent at the upper range of the federal subsidy range wouldn't really be impacted much:

Assuming that NM, OR & NV are "in the clear" for federal subsidies (and this still isn't clear), you'd have to subtract around 175K from the total; call it 6.5 million who would actually lose their federal tax credits.

Of those, let's assume that perhaps 5% are at the upper end of the tax credit limit and are therefore only receiving nominal credits (say, $30 or less per month). For those folks, losing these credits, in and of itself, would be annoying but hardly devastating; I have to imagine they won't drop their coverage if that was the only change (which it isn't, but I'll get to that in a moment).

However, I was just spitballing that 5%; I didn't do the actual math to see just how many people at various income levels would be seriously hurt. Fortunately, over at the Huffington Post, Jeffrey Young has done exactly that:

SAN MATEO, California— A landmark bill to extend subsidized health care to some 1.25 million undocumented immigrants in California — more than one third of whom are Asians and Pacific Islanders, passed the California Senate’s Health Committee on April 15.

Senate Bill 4, also known as the 2015 Health for All Act, sponsored by Sen. Ricardo Lara (Dem-Bell Gardens) passed 7-0, according to reports by the Orange County Register.

Capital Public Radio’s KXJZ News said the bill was supported unanimously by the committee’s Democratic members, Republican members of the same committee, however, abstained from the vote.

At the health law’s core is a “three-legged stool” approach to reforming these markets: new rules that prevent insurers from denying coverage or raising premiums based on preexisting conditions, requirements that everyone buy insurance, and subsidies to make that insurance affordable.

OLYMPIA, Wash. – Washington Healthplanfinder today announced that 170,101 Washingtonians have currently signed up for a Qualified Health Plan or renewed their health coverage through www.wahealthplanfinder.org. Of the total number of Qualified Health Plan enrollees, more than 16,000 enrolled during the spring special enrollment period.

The spring special enrollment period, which ran from Feb. 17 to April 17, was previously available to Washingtonians who recently became aware of the tax penalty for not having health insurance or were unable to complete their applications due to technical issues by the Feb. 15 deadline.

Christopher Koller, president of the Milbank Memorial Fund, recently provided a SHOP exchange enrollment summary in written testimony submitted for a state legislature hearing in Hawaii.

Out of curiosity, I took a look at his presentation, hoping to find some updated numbers out of Hawaii (I don't have anything for the Aloha State since 2/21). Instead, on 3 different slides, I found...ACASignups.net listed as a data source.

Yup, I've now been repeatedly cited in an official presentation to a Joint Committee Meeting of the Hawaii State Legislature.

The numbers are in: It appears that Oregon consumers were fairly price sensitive when it came to choosing health plans this year.

LifeWise had the lowest rates, at $222 a month for a 40-year-old Portlander on a silver plan. Probably not coincidentally, it more than doubled its individual membership in plans that comply with Affordable Care Act guidelines.

As of March 31, LifeWise has nearly 37,000 members in ACA-compliant plans, up from 4,735 last year, according to the Oregon Insurance Division.

The article goes on to tally every single one of Oregon's individual policy QHP enrollees. The bad news is that they don't break them out by exchange vs. off-exchange. The good news is that they specifically clarify that these are all ACA compliant policies (ie, no "grandfathered" or "transitional" numbers included):

Last year, after a bunch of different piecemeal data points and surveys came in, I estimated off-exchange (that is, directly via the insurance companies) private insurance policy enrollments were likely around 8 million or so, of whom perhaps 7 million paid at least their first premium, plus another 4-5 million or so "grandfathered" or "transitional" enrollments. Add these to the 7 million (paid) exchange-based enrollees and you had perhaps 18-19 million people on the private individual market for 2014.

This year, I actually have less hard off-exchange data to work with so far (only a handful of states), but since early February I've been operating on a rough estimate of around 80%. That is, whatever the exchange-based QHP figure is at any given time, I'm pretty sure that the off-exchange QHP tally is somewhere around 80% of that number.

If you look at The Graph lately, you'll notice that in addition to extending the projections out for the full calendar year, I've also recently added the Effectuated Enrollment line, which hovers around the 10.0 - 10.1 million enrollee mark for most of the year.

I've explained this several times before, but with the recent confirmations from states like Idaho and Massachusetts that the 2015 payment rate is likely higher than the 88% "rule of thumb" that I've been using for nearly a year now, yesterday's data showing that the #ACATaxTime enrollments appear to be roughly 3,000/day nationally (I overestimated by a lot), and today's confirmation out of California that my estimate of at least 7,000 additional QHP selections per day during the "normal" off-season is likely underestimating things a bit, it seems like a good time to modify things.

With that in mind, here's 2 tables which lay out how I expect the rest of 2015 ACA exchange enrollments and attrition to play out. The first table assumes that 88% of enrollees pay their 1st premium; the second table assumes 90%. Other than that, both are identical and assume:

Sally Pipes, according to her byline in Forbes, is the President of the Pacific Research Institute (another one of those "free market think tanks" along the lines of the American Enterprise Institute, Heritage Foundation, bla bla bla).

I want to be clear about this up front: I have no problem with private insurance exchanges (at least no moreso than I have a problem with private, for-profit health insurance in general). Companies such as eHealth Insurance and it's brethren are perfectly fine, and I wish them well.

Having said that, Ms. Pipes has written an unbelievably disingenuous essay. Let's take a look, shall we?

The federal government is desperate for Americans to enroll in Obamacare’s exchanges. But most people have refused.

This is incredibly useful! Not only have they given an updated #ACATaxTime tally (22,659 as of 4/12, up from 18,000 as of 4/05), but they've also given the other off-season QHP enrollments for California since Open Enrollment ended. As a bonus, they've even broken out those other QHPs by the specific reason, which is a first for any exchange report, I believe!

Earlier I posted about a new Bloomberg News poll which shows that only 35% of the population wants to repeal the ACA, while 63% want to either keep it as is or give it a few years to see how it goes with only minor tweaks.

As you'll recall, in every state but 3 (CO, MA & ID), the ACA exchanges are allowing people who a) had to pay the "shared responsibility penalty" last year; b) missed the 2/22 deadline for enrolling in healthcare coverage this year and c) "didn't know" about the penalty until after the deadline (honor system!) were given a roughly 6-week period to go ahead and enroll for the rest of 2015.

A couple of weeks back I reported that I had seriously overestimated the number of people who were likely to take advantage of the ongoing tax filing season Special Enrollment Period, which I've shortened to #ACATaxTIme. The time window for most states is from 3/15/15 - 4/30/15, although a few states started a bit earlier/later.

I had made a very rough "spitball" guess that perhaps somewhere between 600K - 1.2 million people might select exchange policies during this SEP, based on extremely vague information about just how many people actually qualified.

A few months later, I again laid into her for a rather lame "Obamacare Raised My Rates 36x!!" tweet that she sent out which, while not actually proven false, certainly didn't include any supporting evidence, details or context whatsoever.

Apparently the answer to the question "How many times will they vote to repeal the ACA before giving it up already?" is "67" (or in the mid-50's, depending on your definition).

After five years and more than 50 votes in Congress, the Republican campaign to repeal the Affordable Care Act is essentially over.

GOP congressional leaders, unable to roll back the law while President Obama remains in office and unwilling to again threaten a government shutdown to pressure him, are focused on other issues, including trade and tax reform.

Less noted, senior Republican lawmakers have quietly incorporated many of the law's key protections into their own proposals, including guaranteeing coverage and providing government assistance to help consumers purchase insurance.

And although the law remains very unpopular with GOP voters, more than 20 million Americans now depend on it for health benefits, making even some of the most conservative Republicans loath to cut off coverage.

Thanks to Jesse LaGreca for the heads up on this piece of idiocy from The Daily Signal, aka "One of the heads of the Heritage Foundation Hydra":

Forcing States to Recognize Gay Marriage Could Increase Number of Abortions

In a nutshell: A reduction in the opposite-sex marriage rate means an increase in the percentage of women who are unmarried and who, according to all available data, have much higher abortion rates than married women. And based on past experience, institutionalizing same-sex marriage poses an enormous risk of reduced opposite-sex marriage rates.

--It was actually a lot better than I was expecting. No, it's not in the upper echelon of Pixar's library, but it's a solid addition. I'd rank it about 10th out of the 14 Pixar movies to date (below Ratatouille and WALL-E, but above Brave, A Bug's Life, Cars or Cars 2).

--Pixar's biggest problem these days is twofold: First, they set the bar so high with masterpieces such as Toy Story 2 & 3, Finding Nemo, The Incredibles, Finding Nemo and Up that when they make a movie that's "merely" very good it seems "disappointing" by comparison.

At the same time, when Pixar was kicking ass and taking names, they also had very little serious competition; the other studios tried to ape Pixar technically, but without having the storytelling/character/dialogue chops. That's changed over the past few years, however; movies like How to Train Your Dragon, Tangled, the Lego Movie, (the first) Despicable Me, (the first) Ice Age and Wreck-It Ralph have proven that the other studios have seriously upped their game. That's good for everyone, but it also ups the ante further for Pixar these days.

Florida Gov. Rick Scott announced Thursday that his administration will file a lawsuit against the federal government for threatening to withhold more than $1 billion in funding for hospitals if the state fails to expand Medicaid.

“It is appalling that President Obama would cut off federal health care dollars to Florida in an effort to force our state further into Obamacare,” Scott said, citing a 2012 Supreme Court ruling that said the federal government couldn’t put a “gun to the head” of states to force them to expand Medicaid under the health care law.

The Obama administration quickly accused Scott of misconstruing that court decision because the state is not being forced to do anything. And White House spokesman Josh Earnest blasted the governor for putting politics above people.

1:00 – 2:00 p.m.
Session 1 – How Making Numbers Accessible and Data Visualization Made One Person’s Website Newsworthy at the National Level

The Supreme Court King v. Burwell decision is expected to be announced "sometime in June", which means for all I know, the announcement could be announced in the middle of my presentation...although it's more likely to come out a week or so later. Guess I better prep 2 sets of notes...

The HHS Dept. reported that exactly 97,079 people had selected private policies in Idaho via their all-new state-based exchange during 2015 Open Enrollment (including the "standing in line" period).

Unlike most states, Idaho chose not to participate in any sort of special tax filing season enrollment period (MA & CO are the other two which didn't do so; every other state is still allowing enrollment for people who had to pay the fine last year and didn't make the cut this year until April 30th, except for WA which cuts things off today and VT which bumped theirs out until the end of May).

While Idaho, like every state, does still allow people to enroll during the off-season if they have a major life change (getting married/divorced, having a baby, moving, losing other coverage, etc), that tends to be cancelled out by other people dropping their coverage for similar reasons.

NOTE 11/3/15: This post is actually from last spring, but given Marco Rubio's recent climb in GOP primary polling, I figured it was worth dusting off...

NOTE 6/17/16: OK, I'm dusting it off again in honor of Rubio's glorious return to the political scene after his humiliating defeat in the GOP Presidential primary...

Now that Florida GOP Senator Marco "Dry Lips" Rubio has officially launched his 2016 Presidential campaign, my long-time obsession with his ill-fated "Florida Health Choices" project from his days as the Speaker of the FL House has taken on a bit more relevance.

As I recently noted, I actually question the 16 million number; by my count it's actually more realistically like 14-15 million, so there's that.

I also noted in response that the fallout of the plaintiffs winning King v. Burwell will cause a lot more than 5 million people to lose their healthcare coverage. Technically speaking, here's the hard numbers:

"Hello, YouTube. I'm kinda having a difficult decision," Webb lamented in the 3-minute video. "I don't know which party to vote for. ... I don't know whether to go for a Republican or a Democrat -- and I'm serious. Because I asked myself, I said, 'Which party has helped me out the most in the last, I don't know, 15 years? Twenty?' And it was the Repub-, err, Democrat Party. The Democrats."

"I mean if it wasn't for Obama and that Obamacare, I would still be working," Webb continued. "With Obamacare, I got to retire at age 50. Because if it wasn't for Obamacare I would had to work till I was 65 and get on Medicare because health insurance is expensive."

Webb stressed how valuable it was that he'd been able to retire so early and still had health care coverage. He also noted that Obamacare reimburses him for his gym membership.

While this was screaming out as a big red flag, I grudgingly accepted it...only to have the rug yanked out from me when the official ASPE report came out in March, giving the official final number as 12,625...which is right in line with what I was expecting in the first place (around a 50% increase over their total in April 2014, and 17% over their total as of September 2014).

Historically, Medicaid (and to a lesser extent, the CHIP program for children) has carried a certain stigma, since it's traditionally been reserved for the very poor. Many people enrolled the program have been embarrassed/ashamed to admit that they needed the assistance, and many who qualified for the program even under the pre-ACA rules never actually signed up based on the "shame" factor (still others didn't enroll because they simply didn't know that they qualified or didn't understand the procedure/paperwork for doing so).

With that Affordable Care Act, that all changed (well, in the states which expanded Medicaid, anyway). Yes, it's still limited to the poor, but there's a difference between being "dirt poor" and "working poor" (and yes, I understand that many "dirt poor" people work their butts off...I'm talking about general societal perception here). Suddenly, millions of people who considered themselves "lower middle class" (or otherwise "not poor", anyway) found themselves being able to enroll in Medicaid alongside the "dirt poor".

Hmmm...this is a bit surprising. The last report out of MNsure stated that they had added 1,405 QHP selections in the 15 days from 2/21 - 3/08, or 94 per day. I assumed that as today's tax filing deadline approached, this rate would increase as procrastinators scrambled to get their taxes filed under the wire. Instead, however, this is their latest report:

61,874 - 61,109 = Just 765 people enrolling over the 36 days since the prior report, or just 21 people per day. ACA exchange enrollments have actually slowed down substantially over the past month compared to the prior 2 weeks (which were after open enrollment ended). If this slowdown is representative of the whole country, then instead of several hundred thousand #ACATaxTime enrollees, we might be looking at fewer than 100K. However, this isn't nearly enough to draw any conclusions from yet.

So far there have been two comprehensive post-Open Enrollment Period reports released. The first was for Washington State, posted a couple of weeks ago; the second was for Massachusetts, posted last week. While both reports were chock full of all sorts of data-nuggety goodness, including updated paid QHP numbers, neither one included one crucial number: How many total QHP selections there have been in each state since Open Enrollment ended in February.

Since today is the official deadline for filing your taxes, I thought it'd be a good time to remind people that if you had to pay the non-coverage tax penalty last year (ie, the "Individual Shared Responsibility Provision"), were (somehow) unaware of it's existence and didn't find out about it until after 2/15/15, you can still enroll in healthcare coverage via the Tax Filing Season Special Enrollment Period (or #ACATaxTime as I put it) as late as April 30th in most states:

As noted above, 3 states aren't offering any sort of tax penalty-specific enrollment period, and 2 other states have different ending deadlines for the SEP: Washington State ends theirs on Friday the 17th, while Vermont is extending theirs all the way out until the end of May.

The ACA is not, by any means, a perfect law. As a single-payer advocate, I find it ironic and a bit absurd that I've received so much praise and attention over the past year and a half for meticulously tracking the enrollment numbers every day...when none of that tracking would even be necessary if we simply shifted to a single-payer healthcare system of some sort. I've made this point before, of course.

Still, the fact remains that the law is generally working, for the most part, and while parts of it are pretty confusing, there are some parts which quite simply aren't. Yes, the law should be as easy to understand as possible. Yes, there are plenty of situations where the government, the insurance companies, the exchange personnel, the brokers/navigators or even the hospitals/doctors are to blame for errors, but I'm not addressing any of those cases here.

However, at the end of the day, the actual enrollees do need to take some bare-minimum level of personal responsibility for their decisions.

Yeah, I know, this is the 3rd off-topic post I've made in as many days, but it's kind of a slow week and I'm procrastinating on my day job at the moment. Besides, this is kind of nagging at me.

Hillary Clinton's new campaign logo (the "Arrow-H" or whatever) has been the subject of way too much discussion already, but I'm a website developer (if not really a graphic designer) so I can get away with it to a point.

The other day I noted that the only major issue I have with it is that mashing the primary red & blue colors up against each other is always problematic because those colors tend to bleed into each other (either literally on a print job or figuratively when you're looking at them). It's not Hillary's fault that the U.S. flag happens to include 2 colors that clash, but it is what it is.

My suggestion was to simply add a thin white border around the arrow to add some space between the blue and red, but I didn't actually do so; here's how that looks, and I think that just this simple tweak improves it tremendously:

If the Supreme Court rules for the plaintiffs in King v. Burwell, the thirty-four states without their own exchanges will come under immense pressure to create them. But there’s a catch, one that so far has gone unmentioned in the debate over King. Could residents of the states with new state-based exchanges even qualify for subsidies?

I don't have time to do a full write-up this morning (ironically because I have to take my kid to a doctor's appointment), but here's the main takeaway:

WASHINGTON, D.C. -- The uninsured rate among U.S. adults declined to 11.9% for the first quarter of 2015 -- down one percentage point from the previous quarter and 5.2 points since the end of 2013, just before the Affordable Care Act went into effect. The uninsured rate is the lowest since Gallup and Healthways began tracking it in 2008.

OK, today's the Big Day; Hillary Clinton has Finally, Officially, For Realz! announced that yes, she is indeed running for President of the United States in 2016.

Everyone's going nuts about it at the moment (even though it's the worst-kept secret in history). I don't have a whole lot to say about my actual feelings about her running/being the nominee yet, and I haven't even watched the launch video yet, but as a website developer, I do have 3 minor gripes and one observation about her all-new campaign website, HillaryClinton.com:

First, the quibbles:

First, while "tooltips" (the little pop-up labels when you roll over something) can be useful for link icons which aren't immediately obvious, they should never be used for text links, especially when the tooltip is exactly the same as the link itself (Iowa / Iowa). It obscures the links below it without providing any useful information.

Second, while translucent overlays can also be very effective, it's a bad idea to do this for drop-down menus, since it tends to make it more difficult to read the drop-down links over the text behind it.

Third (this is more of an "optics" thing), I'm assuming that IA, NH, NY, NV & SC are the first states to hold their primaries. While I can understand listing them first, she probably should have still listed all 50 states (along with DC, Puerto Rico, Guam, American Samoa & the US Virgin Islands) as well for the whole "reaching out to all Americans" vibe. Grey out the other 45+ links if need be, but list them (double-columned if necessary).

Part of the key to the successful enrollment of over 8 million* people last year and around 12 million* this year in the various ACA exchange policies has been the army of so-called "navigators" or "assisters" who, along with private health insurance brokers, helped educate millions of people about how the exchanges work, what their best options were and how to go through the procedure.

Unfortunately, some states (those run by administrations of a certain crimson hue, shall we say) decided, in their effort to obstruct Obamacare at every possible opportunity, to be utter jackasses by ginning up absurd regulations/restrictions about who "qualified" to be an ACA navigator.

This article about New Hampshire reveals 3 noteworthy bits of information: First, it looks like at least one of the 37 HC.gov states will be reporting their exchange enrollments monthly during the off-season, even if the HHS Dept. itself refuses to do so:

The New Hampshire Insurance Departmentrecently began requiring insurance companies selling plans through the marketplace to submit monthly enrollment numbers.

Second, here's the first results of those monthly reports:

According to the latest numbers, a total of 45,504 people had signed up for plans in New Hampshire by April 1

The impending King v. Burwell Supreme Court decision will cast an even larger shadow over the ACA over the next 2 months (the decision is expected to be announced in June), as exchanges in 6 of the 14 states running their own (State-Based Marketplaces, or SBMs) are at risk of either being abandoned, dissolved or otherwise moved over to the federally-run Healthcare.Gov exchange:

The federal government is threatening to take over Hawaii's health insurance exchange within months and has restricted grant money to support operations of the Hawaii Health Connector.

Jeff Kissel, the Connector's executive director, told lawmakers at a briefing Thursday that if the exchange created by the Affordable Care Act does not get state funding soon, the federal government will abolish Hawaii's marketplace and run it directly.

NewsBusters, for those who aren't familiar with it, is a right-wing nutjob "news/expose" site which prides itself on "exposing and combating liberal media bias". Think of them as the poor man's Breitbart and their fan base as that of Free Republic with less frothing at the mouth. I'm rather proud to say that they even posted a hit piece on me about a year ago.

According to the February 18, Washington Post, as many as six million Americans faced the “unwelcome surprise” of a penalty 2015. Of course, many people might not have suffered that shock if the broadcast news networks had discussed the penalty more. But ABC, CBS and NBC evening newscasts failed to mention the tax penalty in 91.1 percent of stories (41 of 45) about the Affordable Care Act between October 1, 2014, and April 5, 2015.

Rhode Island's ACA exchange hasn't suffered from the technical glitches which are still causing problems for some states (particularly Vermont and Minnesota), but HealthSource RI does have one major problem to deal with: Funding. It's a small state with a smaller customer base for the exchange; 31,500 enrollees isn't a lot of people to cover the costs. As a result, the Governor of Rhode Island has come up with a healthcare policy tax idea which is being batted around.

The article goes into the pros and cons of the tax as opposed to simply dropping the exchange altogether and moving to Healthcare.Gov. Aside from the biggest and most obvious downside of doing so (King v. Burwell), it's also not certain that making the move would actually save any money, since HC.gov still takes some bucks to run:

Hey, remember the story from earlier about how ACA Medicaid expansion in Montana (which failed by 1 vote due to a comedy of errors resulting in a Democratic state legislator who supported the effort inadvertantly voting against it) is back on the table again and looks poised to finally go through?

Well, apparently the Koch Bros and their puppet organization, "Americans for Prosperity" (AFP), are also aware of this and have been lobbying, screaming and generally making a nuisance of themselves throughout Montana in an attempt to prevent this from happening (because God knows that 45,000 - 70,000 low-income Americans having healthcare coverage would be a horrible thing for some reason or another).

In fact, they've been so obnoxious about their efforts that the people of Montana, generally considered a fairly "red" state which you'd think would be partial to their position, have pretty much asked them to GTFO and go pound sand:

For obvious reasons, aside from whatever #ACATaxTime bump comes out of the next week or so, things will likely be pretty quiet and steady for The Graph for the rest of the year...assuming, of course, that the Supreme Court shoots down the King v. Burwell plaintiffs. If the King plaintiffs win, all bets are off and every line on the right half of the extended graph below (to the right of June) will probably look very different.

That major caveat aside, assuming that my (recently corrected) projections prove to be reasonably on the mark, this is what I'm expecting private QHP enrollments via the ACA exchanges to look like for the rest of 2015. The year should wrap up with roughly 13.7 million total QHP selections; of those, around 12.0 million will likely pay their first premium; and of those, roughly 10.0 million will likely still be enrolled (effectuated) as of December.

Here's the numeric table from which the extended graph data comes (click for higher-res version):

I'm back from a short vacation to Chicago (we had a blast, thanks for asking...visited the Shedd Aquarium, Adler Planetarium and Museum of Science & Industry), so obviously my in box has built up quite a bit of ACA news over the past week.

It'll take awhile to sift through everything, but in the meantime there are some state-specific developments which stand out:

MONTANA: A couple of years back, Montana held a vote on the ACA Medicaid expansion provision. It was a tight vote, but should have passed...unfortunately, one state legislator accidentally voted the wrong way on the bill. Seriously:

Some states have declined to expand Medicaid because they oppose Obamacare. Others worry about the financial burden of expanding the entitlement. But there appears to be only one state where the Medicaid expansion failed due to a Democratic legislator accidentally voting against it.

For months now, Michigan's implementation of the Affordable Care Act's Medicaid expansion provision has defied expectations, enrolling far more than the 477K - 500K expected. A couple of weeks ago it managed to break the 600,000 mark, peaking at 603,681 people, and I've been wondering for quite awhile when the growth might finally stop.

The Massachusetts Health Connector board held their monthly meeting today, which included an updated enrollment report which is chock-full of all sorts of data-nerd charts and graphs; a bonanza for folks like myself. Best of all, it runs all the way through 3/31, making the the most up-to-date report I have for any state at the moment.

Tax Experts Team Up with Covered California To Urge the Uninsured To Get Health Care Coverage

More Than 18,000 Californians Have Taken Advantage of Limited Special-Enrollment Opportunity; Consumers Are Encouraged to Sign Up by April 30

...“The Affordable Care Act is clear: All who can afford health insurance must buy it, and the good news is that it is more affordable than ever before,” said Covered California Executive Director Peter V. Lee. “It’s important for Californians without health coverage to sign up now to avoid the increasing tax penalty they will face in 2015 if they remain uninsured.”

Lee said that more than 18,000 consumers have taken advantage of the special-enrollment opportunity since it began Feb. 23.

The state Legislature has killed a $69 million tax on health-insurance policies proposed by Gov. Cuomo to pay for the administrative costs of continuing New York’s ObamaCare exchange, The Post has learned.

Cuomo’s office initially said the levy — which would have cost about $25 per policy — was needed to make up for federal funds no longer available to cover operating expenses of the New York Health Exchange under the Affordable Care Act.

But lawmakers balked, arguing the new tax was counterintuitive to the goal of making health insurance more affordable.

As for how the NY exchange will be funded, apparently it may just be a matter of shifting $69 million in existing funds over from somewhere else:

The industry’s spokeswoman said revenues from existing state taxes on health insurance — totalling more than $5 billion and amounting to 5 percent of premiums — could easily cover the $68.9 million cost to operate the New York Health Exchange.

Some of my projections/estimates I'm pretty confident in. Others are more shaky, and once in awhile I'm just doing the best I can given extremely vague, partial data to work with. And when it comes to unknown factors, I make that point as clear as I can.

...aside from the King v. Burwell SCOTUS decision (which isn't expected until sometime in June), the other Big Mystery is just how many people a) qualify for the #ACATaxTime SEP, and b) how many of those will actually enroll during this (roughly) 6-week period.

After a TON of patching together data points here and there and discussing/debating the factors with other healthcare wonks/reporters, I stated:

Well, that was anticlimactic. After weeks of me whining about the lack of post-Open Enrollment data, Healthcare.Gov has finally stated (sort of buried in the middle of a press release) that around 36,000 additional people had enrolled via Healthcare.Gov as of March 29th via the Tax Filing Season Special Enrollment Period (aka #ACATaxTime):

As of March 29, about 36,000 consumers have selected plans using the tax special enrollment period in States using the Federally-facilitated Marketplace.

Now, all of those bold-faced phrases are important, because the actual Tax Filing Season SEP didn't start until 3/15, and this doesn't include any of the 14 state-based exchanges (really only 11 of them, though, since 3 states aren't offering #ACATaxTime). Also, from the exact wording, this does not include those who enrolled via "Qualifying Life Events" (ie, getting married/divorced, giving birth/adopting a child, moving to a new state, losing your existing coverage and so on).

Detroit — On the eve of the first anniversary of the Healthy Michigan Plan, Gov. Rick Snyder said Tuesday more than 603,000 Michiganians have enrolled since the expanded Medicaid Program launched on April 1, 2014.

Mazel Tov!! Over 600,000 Michiganders enrolled in a program enabled by and paid for by Obamacare! I'm sure they'll mention that in the 2nd paragraph, right?

The number exceeds by more than 100,000 people the two-year enrollment projections made prior to the program’s launch. The Healthy Michigan Plan provides health insurance to low-income working people for a minimal cost.